Wichita, Kansas has been selected as the single worst place to live in the United States if you have fall allergies, according to the Asthma and Allergy Foundation of America. Wichita was closely followed by Jackson, Mississippi and Knoxville, Tennessee, perennial top placers in previous allergy capitals lists.

The AAFA’s annual Fall Allergy Capitals list is a compilation of the 100 largest metropolitan centers in the United States, ranked by how problematic they are for people with fall allergies. The list is based on pollen counts, allergy medication use and the number of allergists in the area.

Without further ado, here are AAFA’s picks for this year’s top 10 most challenging places to live with fall allergies:

Wichita, KS

Jackson, MS

Knoxville, TN

Louisville, KY

Memphis, TN

McAllen, TX

Baton Rouge, LA

Dayton, OH

Chattanooga, TN

Oklahoma City, OK

As can be seen, the top offenders tend to be located in the south, as was the case with the spring capitals list[1]. Dayton, Ohio was the only northern city to appear in the top 10 in both of this year’s lists.

Many of the cities in this list have been singled out before as challenging for people with allergies. In fact, since 2009, the top 10 fall capitals have remained largely the same, only shifting in rank. These include Wichita, Knoxville, Chattanooga, Louisville, McAllen, Dayton and Oklahoma city. If you suffer from seasonal allergies in the autumn, be prepared for a challenge if you live in any of these cities!